End-of-life care in children with hematologic malignancies
End-of-life care in children with hematologic malignancies
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DOI：
10.18632/oncotarget.21188
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发表时间：
2017-10-27
期刊：
影响因子：
--
通讯作者：
Kuhlen, Michaela
中科院分区：
文献类型：
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作者：
Hoell, Jessica I.;Warfsmann, Jens;Kuhlen, Michaela
简介：血液恶性肿瘤（HM）是儿童期最常见的肿瘤。尽管总生存率有所提高，但它们仍然是儿童癌症死亡的主要原因。 目的：确定儿科姑息治疗 (PPC) 中 HM 儿童的比例，并与颅外实体瘤儿童（非 HM 患者）相比，确定其临床特征和症状。患者和方法：本研究是一项单中心回顾性队列研究，对象是由大型专业 PPC 团队护理的患者。结果：纳入 15 名 HM 患者和 50 名非 HM 患者。 HM患者得分显着高于非HM患者的症状是粘膜炎、活动困难、嗜睡、疲劳、瘀点和苍白。 HM 患者输血更为频繁，但没有在任何儿童中观察到大的外出血。患者需要各种各样的药物和器具，其中吗啡是最常用的处方药物。在研究期间，越来越多且多年来甚至不断增加的 HM 患者（不在 PPC 团队的照顾下）在医院死亡，其中三分之二是在 ICU 中死亡的。结论：HM 儿童被转诊至门诊 PPC，几乎获得了晚期白血病的完整临床表现。值得注意的是，在我们中心，在家中死亡的 HM 儿童数量正在减少，相反，相当大比例的儿童接受了高强度的医院护理，包括新型抗癌疗法。因此，这些患者在医院死亡的风险似乎增加，因为经常错过将他们转移到姑息治疗的最佳时机。
Introduction: Hematologic malignancies (HM) represent the most common neoplasms in childhood. Despite improved overall survival rates, they are still a major contributor to cancer death in children.Aims: To determine the proportion of children with HM in pediatric palliative care (PPC) and to identify the clinical characteristics and symptoms in comparison to children with extracranial solid tumors (non HM patients). Patients and Methods: This study was conducted as a single-center retrospective cohort study of patients in the care of a large specialized PPC team.Results: Fifteen HM and 50 non HM patients were included. Symptoms in which HM patients scored significantly higher than non HM patients were mucositis, difficulty moving, somnolence, fatigue, petechiae and paleness. Blood transfusions were more frequently administered to HM patients, but large external hemorrhage was not observed in any child. A large variety of drugs and appliances were needed by the patients, with morphine being the most frequently prescribed drug. During the study period, a much larger and over the years even increasing number of HM patients (not in the care of the PPC team) died in hospital with an (assumed) curative intent, with two thirds dying in the ICU.Conclusions: Children with HM were referred to outpatient PPC with almost the full clinical picture of advanced leukemia. Noteworthy, the number of children with HM dying at home is decreasing in our center, instead a substantial proportion received high-intensity medical hospital care including novel anticancer therapies. These patients thus seem to be at an increased risk of dying in hospital as the right time to transfer them to palliative care is oftentimes missed.